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Is strain echocardiography a more sensitive indicator of myocardial involvement in patients with multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2? Cardiol Young 2022; 32:1657-1667. [PMID: 35322771 DOI: 10.1017/s1047951122000646] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the early myocardial dysfunction detected by strain echocardiography in children with multisystem inflammatory syndrome related to SARS-CoV-2 infection. METHODS This cross-sectional study was conducted with 47 patients diagnosed with MIS-C and 32 healthy age- and gender-matched children. All patients underwent two-dimensional, colour, pulsed, and tissue Doppler, and 2D speckle tracking echocardiography examination at admission, 2 weeks, and 2 months after discharge. The MIS-C patient group was compared with the control group. Echocardiographic changes in MIS-C patients during follow-up were evaluated. RESULTS Of 47 patients, 30 (63.8%) were male and 17 (36.2%) were female. The mean age at diagnosis was 9.1 ± 4.3 (1.25-17) years. At admission, 25 patients had abnormal findings on conventional echocardiography. Among them, eight patients had left ventricular systolic dysfunction. Ejection fraction and fractional shortening were significantly lower in the patient group at admission compared to controls (p = 0.013, p = 0.010, respectively). While the ejection fraction was <55% in eight patients, and global longitudinal strain was lower than -2SD in 29 patients at admission. Global longitudinal strain z-score <-2SD persisted in 13 patients at 2-month follow-up. Ejection fraction increased above 55% in 3.42 ± 0.53 days in 7 of 8 patients with left ventricular systolic dysfunction, ejection fraction was 51% at discharge in one patient, and left ventricular systolic dysfunction persisted at the 6-month of follow-up. CONCLUSION These results confirmed that speckle tracking echocardiography is more likely to detect subclinical myocardial damage compared to conventional echocardiography. In addition, it is a valuable method for follow-up in this patient group.
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Kayabey Ö, Tuncer T, Deveci M, Başar EZ, Babaoğlu K. Is there myocardial involvement in children with long-term follow-up for Kawasaki disease? A study based on two-dimensional speckle tracking echocardiography. Turk Arch Pediatr 2021; 56:44-50. [PMID: 34013229 DOI: 10.5152/turkarchpediatr.2020.20193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022]
Abstract
Objective This study aimed to determine the possibility of subclinical myocardial dysfunction detected by strain echocardiography in the late period of children with Kawasaki disease. Material and Methods The study enrolled 30 patients with Kawasaki disease with a follow-up period of at least 12 months and 30 healthy age- and gender-matched children. During the follow-up period, standard echocardiography, pulsed and tissue Doppler, and strain echocardiography were recorded for both groups. Results The mean age at the time of the diagnosis was 2.6±2.3 years (2 months-11 years). The mean follow-up period after the diagnosis was 3.55±2.20 years. Conventional echocardiography, M mode, pulsed and tissue Doppler values, and myocard performance index did not reveal significant differences. Left ventricle strain and strain rate parameters obtained by apical four-, three-, and two-chamber views did not show statistical differences between patients and controls. There was a positive correlation between the duration of follow-up and global four- and three-chamber longitudinal strain and global longitudinal strain values (r=0.465, p=0.010; r=0.414, p=0.023; r=0.492, p=0.006, respectively), whereas global radial strain showed negative correlation (r=-0.517, p=0.003). Conclusion The analysis of systolic strain and strain rate did not detect a subclinical myocardial dysfunction in the long-term follow-up of Kawasaki disease. However, strain values showed variability with the follow-up periods, which indicates that Kawasaki disease might cause left ventricular dysfunction in the later phases. Therefore, a follow-up of children with a diagnosis of Kawasaki disease is of capital importance.
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Affiliation(s)
- Özlem Kayabey
- Department of Pediatric Cardiology, Kocaeli University Faculty of Medicine Kocaeli, Turkey
| | - Tunç Tuncer
- Department of Pediatric Cardiology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, İstanbul, Turkey
| | - Murat Deveci
- Department of Pediatric Cardiology, Trakya University School of Medicine Edirne, Turkey
| | - Eviç Zeynep Başar
- Department of Pediatric Cardiology, Kocaeli University Faculty of Medicine Kocaeli, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Kocaeli University Faculty of Medicine Kocaeli, Turkey
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Pilania RK, Jindal AK, Bhattarai D, Naganur SH, Singh S. Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis. Front Pediatr 2020; 8:526969. [PMID: 33072669 PMCID: PMC7542237 DOI: 10.3389/fped.2020.526969] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD) is now a common cause of acquired heart disease in children. Coronary artery involvement is the most serious complication in children with KD. Several non-coronary complications have now been identified in this condition but these are often overlooked. Myocarditis is an integral component of KD and may be more common than coronary artery abnormalities. Pericardial involvement and valvular abnormalities have also been observed in patients with KD. KD shock syndrome is now being increasingly recognized and may be difficult to differentiate clinically from toxic shock syndrome. Endothelial dysfunction has been reported both during acute stage and also on follow-up. This may be a potentially modifiable cardiovascular risk factor.
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Affiliation(s)
- Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmagat Bhattarai
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Hanumantacharya Naganur
- Department of Cardiology, Advances Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Song ES, Yoon S, Cho JH, Yang EM, Cho HJ, Choi YY, Ma JS, Eom GH, Cho YK. Serial evaluation of myocardial function using the myocardial performance index in Kawasaki disease. World J Pediatr 2018. [PMID: 29532436 DOI: 10.1007/s12519-018-0142-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is known as systemic vasculitis, and more than half of the patients with KD have myocarditis, which can induce ventricular dysfunction. In this study, we evaluate left ventricular (LV) dysfunction in patients with KD based on the myocardial performance index (MPI) using pulse Doppler (PD) and tissue Doppler imaging (TDI), from the acute to convalescent phases. METHODS We retrospectively studied 89 children diagnosed with KD from January 2010 to August 2012. We assessed the presence of coronary artery lesions (CALs) and the LV ejection fraction, PD-MPI, and TDI-MPI at diagnosis, and 2, 14, and 56 days after intravenous immunoglobulin (IVIG) treatment. We enrolled 70 healthy children as a control group. RESULTS The ejection fraction in patients with KD at diagnosis (67.3 ± 0.9%) was lower than that in the control group (69.8 ± 0.8%, P = 0.035), and the LV TDI-MPIs for patients with KD at diagnosis (0.49 ± 0.01) and 2 days after IVIG treatment (0.48 ± 0.01) were higher than those in the control group (0.45 ± 0.01, P = 0.002, P = 0.033, respectively). No significant differences were found in the LV dysfunction between the patients with complete and incomplete KD. Septal TDI-MPIs in patients with KD with CAL at diagnosis (0.52 ± 0.02) were higher than those in patients with KD without CAL (0.47 ± 0.01, P = 0.019). CONCLUSIONS Transient LV dysfunction occurred in patients with complete and incomplete KD in the acute stage. In patients with KD with CAL at diagnosis, the LV dysfunction was more prominent. The PD-MPI and TDI-MPI are useful parameters for assessing LV function in patients with KD.
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Affiliation(s)
- Eun Song Song
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Somy Yoon
- Department of Pharmacology and Medical Research Center for Gene Regulation, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Joo Hyun Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Young Youn Choi
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Jae Sook Ma
- Department of Pediatrics, KS Hospital, Gwangju, South Korea
| | - Gwang Hyeon Eom
- Department of Pharmacology and Medical Research Center for Gene Regulation, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea.
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
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Azak E, Cetin II, Gursu HA, Kibar AE, Surucu M, Orgun A, Pamuk U. Recovery of myocardial mechanics in Kawasaki disease demonstrated by speckle tracking and tissue Doppler methods. Echocardiography 2017; 35:380-387. [PMID: 29239028 DOI: 10.1111/echo.13773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM To investigate myocardial deformation and function during treatment for Kawasaki disease (KD) in children. METHODS We performed speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) in 15 children with KD and 15 healthy children during treatment for KD. STE was performed for longitudinal and circumferential strain (S) and strain rate (SR) at the left ventricle (LV) and for longitudinal S and SR at the right ventricle (RV). TDI was performed at the base of interventricular septum (IVS), LV, and RV. RESULTS Among TDI parameters, Em and ejection time (ET) at IVS, ET at LV and ET at RV obtained obtained before treatment were significantly lower in patients with KD compared to controls. After treatment, in spite of improvements, ET at IVS and ET at RV remained significantly lower in patients with KD compared to controls. Left ventricular global longitudinal and circumferential S and SR values obtained before treatment were significantly lower in patients with KD compared to controls. Left ventricular S and SR values were found to be increased after treatment. However, left ventricular global circumferential S value remained significantly lower in patients with KD compared to controls. There were no significant differences in right ventricular global longitudinal S and SR values between patients and controls before treatment. CONCLUSION During acute phase, patients with KD have reduced global left ventricular S and SR which may be more sensitive indicators of myocardial inflammation. This study showed gradual improvements in left ventricular myocardial function during treatment for KD.
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Affiliation(s)
- Emine Azak
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ibrahim Ilker Cetin
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Hazım A Gursu
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ayse Esin Kibar
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Murat Surucu
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali Orgun
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Utku Pamuk
- Department of Pediatric Cardiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
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Frank B, Davidson J, Tong S, Martin B, Heizer H, Anderson MS, Glode MP, Dominguez SR, Jone PN. Myocardial Strain and Strain Rate in Kawasaki Disease: Range, Recovery, and Relationship to Systemic Inflammation/Coronary Artery Dilation. JOURNAL OF CLINICAL & EXPERIMENTAL CARDIOLOGY 2016; 7. [PMID: 27182455 PMCID: PMC4866607 DOI: 10.4172/2155-9880.1000432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kawasaki Disease (KD), a systemic vasculitis of medium sized vessels, is the most common cause of acquired heart disease among children in the developed world. Some KD patients demonstrate echocardiographic evidence of depressed myocardial mechanics. However, the incidence, etiology, and reversibility of abnormal mechanics in KD patients remain undefined. METHODS AND RESULTS We retrospectively studied 41 KD patients and measured myocardial strain and strain rate by velocity vector imaging from pre-treatment and convalescent echocardiograms. Pre-treatment procalcitonin, C-reactive protein (CRP), and coronary artery z-scores were obtained in all patients and compared between the groups with preserved versus depressed acute phase mechanics. The change in mechanics between the acute and convalescent phases was also assessed. Patients with initially low longitudinal strain improved by the convalescent period (mean difference - 4.0%; p<0.005) with the greatest improvement occurring in patients with the lowest initial strain (-7.3%; p<0.05). Patients with higher initial strain did not change significantly by the convalescent period. Patients with lower longitudinal and circumferential strain demonstrated higher median procalcitonin levels (1.2 vs. 0.3 ng/mL; p<0.05 and 1.8 vs. 0.4 ng/mL; p<0.05 respectively) and a trend towards higher CRP, but no difference in coronary artery z-scores. Strain rate was not associated with inflammatory markers or coronary artery z-scores. CONCLUSIONS The range of strain found in our cohort was large. Improvement in mean strain was driven primarily by patients with lower initial strain. Lower strain was associated with increased markers of systemic inflammation, but not proximal coronary artery changes.
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Affiliation(s)
- Benjamin Frank
- Department of Pediatrics and Section of Cardiology, Children's Hospital Colorado/University of Colorado, Denver, USA
| | - Jesse Davidson
- Department of Pediatrics and Section of Cardiology, Children's Hospital Colorado/University of Colorado, Denver, USA
| | - Suhong Tong
- Department of Biostatistics, Children's Hospital Colorado/University of Colorado, Denver, USA
| | - Blake Martin
- Department of Pediatrics and Section of Infectious Diseases, Children's Hospital Colorado/University of Colorado, Denver, USA
| | - Heather Heizer
- Department of Pediatrics and Section of Infectious Diseases, Children's Hospital Colorado/University of Colorado, Denver, USA
| | - Marsha S Anderson
- Department of Pediatrics and Section of Infectious Diseases, Children's Hospital Colorado/University of Colorado, Denver, USA
| | - Mary P Glode
- Department of Pediatrics and Section of Infectious Diseases, Children's Hospital Colorado/University of Colorado, Denver, USA
| | - Samuel R Dominguez
- Department of Pediatrics and Section of Infectious Diseases, Children's Hospital Colorado/University of Colorado, Denver, USA
| | - Pei-Ni Jone
- Department of Pediatrics and Section of Cardiology, Children's Hospital Colorado/University of Colorado, Denver, USA
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Numano F, Shimizu C, Tremoulet AH, Dyar D, Burns JC, Printz BF. Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease. Pediatr Cardiol 2016; 37:482-90. [PMID: 26681305 DOI: 10.1007/s00246-015-1303-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
Coronary artery inflammation and aneurysm formation are the most common complications of Kawasaki disease (KD). Valvulitis and myocarditis are also well described and may lead to valvar regurgitation and left ventricular dysfunction. However, functional changes in the right heart have rarely been reported. We noted several acute KD patients with dilated pulmonary arteries (PA) and thus sought to systematically characterize PA size and right-heart function in an unselected cohort of KD patients cared for at a single clinical center. Clinical, laboratory, and echocardiographic data from 143 acute KD subjects were analyzed. PA dilation was documented in 23 subjects (16.1 %); these subjects had higher median right ventricle myocardial performance index (RV MPI), higher ratio of early tricuspid inflow velocity to tricuspid annular early diastolic velocity (TV E/e'), and lower median TV e' velocity compared to the non-PA dilation group (0.50 vs 0.38 p < 0.01, 4.2 vs 3.6 p < 0.05, and 13.5 vs 15.2 cm/s p < 0.01, respectively). Almost all subjects with PA dilation had improved PA Z-score, RV MPI, and TV E/e' in the subacute phase (p < 0.01). There were no significant differences in indices of left ventricle function between PA dilation group and non-PA dilation group. In summary, PA dilation was documented in 16 % of acute KD subjects. These subjects were more likely to have echocardiographic indices consistent with isolated RV dysfunction that improved in the subacute phase. The long-term consequence of these findings will require longitudinal studies of this patient population.
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Affiliation(s)
- Fujito Numano
- Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA. .,Department of Pediatrics, UCSD School of Medicine, Kawasaki Disease Research Center, 9500 Gilman Dr., La Jolla, CA, 92093-0641, USA.
| | - Chisato Shimizu
- Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA
| | - Adriana H Tremoulet
- Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA.,Rady Children's Hospital San Diego, San Diego, USA
| | - Dan Dyar
- Rady Children's Hospital San Diego, San Diego, USA
| | - Jane C Burns
- Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA.,Rady Children's Hospital San Diego, San Diego, USA
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Lee SB, Choi HS, Son S, Hong YM. Cardiac Function in Kawasaki Disease Patients with Respiratory Symptoms. Korean Circ J 2015; 45:317-24. [PMID: 26240586 PMCID: PMC4521110 DOI: 10.4070/kcj.2015.45.4.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/03/2015] [Accepted: 04/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives Respiratory symptoms are often observed in children with Kawasaki disease (KD) during the acute phase. The association of respiratory viruses in children with KD was investigated using multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) and tissue Doppler echocardiography. Subjects and Methods 138 KD patients were included from January 2010 to June 2013. We compared 3 groups (group 1: n=94, KD without respiratory symptoms; group 2: n=44, KD with respiratory symptoms; and group 3: n=50, febrile patients with respiratory symptoms). Laboratory data were obtained from each patient including N-terminal pro-brain natriuretic peptide (NT-proBNP). Echocardiographic measurements were compared between group 1 and group 2. RT-PCR was performed using nasopharyngeal secretion to screen for the presence of 14 viruses in groups 2 and 3. Results The incidence of KD with respiratory symptoms was 31.8%. The duration of fever was significantly longer, and coronary artery diameter was larger in group 2 than in group 1. Tei index was significantly higher and coronary artery diameter larger in group 2 than group 1. Coronary artery diameter, C-reactive protein levels, platelet count, alanine aminotransferase levels, and NT-pro BNP levels were significantly higher and albumin levels lower in group 2 compared with group 3. Conclusion NT-pro BNP was a valuable diagnostic tool in differentiating KD from other febrile viral respiratory infections. Some viruses were more frequently observed in KD patients than in febrile controls. Tei index using tissue Doppler imaging was increased in KD patients with respiratory symptoms.
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Affiliation(s)
- Seul Bee Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Han Seul Choi
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Son
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Xu QQ, Ding YY, Lv HT, Zhou WP, Sun L, Huang J, Yan WH. Evaluation of left ventricular systolic strain in children with Kawasaki disease. Pediatr Cardiol 2014; 35:1191-7. [PMID: 24859168 DOI: 10.1007/s00246-014-0915-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 04/25/2014] [Indexed: 11/25/2022]
Abstract
The current study aimed to assess left ventricular (LV) longitudinal systolic strains in children with KD using two-dimensional speckle-tracking imaging and to analyze the relationship of LV myocardial deformation to coronary lesions and laboratory markers. The study enrolled 101 children with acute KD. An additional 50 age- and gender-matched normal children were enrolled as control subjects. During different phases of KD, echocardiograms were recorded for 61 children. Two-dimensional strain analysis software was used to track myocardial movement and obtain the strain from each LV segment. The LV longitudinal systolic strain decreased significantly in children with acute KD but increased immediately after intravenous immunoglobulin therapy. At 6-8 weeks after the onset of KD, all LV strains had recovered to normal. The LV systolic strain was not associated with coronary dilation in either acute or convalescent KD. In acute KD, aspartate transaminase, alanine transaminase, erythrocyte sedimentation rate, C-reactive protein (CRP), and hemoglobin (Hb) were found to be associated with coronary dilation, whereas LV systolic strains were found to be correlated with elevated CRP and decreased Hb. Speckle-tracking imaging of LV systolic strain was simple and accurate in evaluating LV function during different phases of KD. No association between LV dysfunction and coronary dilation was observed, but a relationship with CRP and Hb was found. Further studies are recommended to validate the current study results and explore further how these findings can improve clinical practice.
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Affiliation(s)
- Qiu-Qin Xu
- Department of Pediatric Cardiology, Children's Hospital Affiliated of Soochow University, 303 Jingde Road, Suzhou, 215003, Jiangsu, China
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Yu W, Wong SJ, Cheung YF. Left ventricular mechanics in adolescents and young adults with a history of kawasaki disease: analysis by three-dimensional speckle tracking echocardiography. Echocardiography 2013; 31:483-91. [PMID: 24804605 DOI: 10.1111/echo.12394] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Myocardial fibrosis and perfusion abnormalities can occur in patients with Kawasaki disease (KD). We explored using the new three-dimensional speckle tracking echocardiography (3DSTE) the left ventricular (LV) mechanics in adolescents and young adults with a history of KD. METHODS Twenty-five KD patients (18 males) aged 17.0 ± 5.2 years, 14 with (group I) and 11 without (group II) coronary aneurysms, were studied. The 3D volume datasets were acquired for quantification of LV global 3D strain, global and regional area strain, systolic dyssynchrony index (SDI), twist, twist gradient (twist/LV length), and ejection fraction. RESULTS The results were compared with those of 14 age-matched controls. Of the 14 group I patients, 6 had left, 2 had right, and 6 had both left and right coronary aneurysms. Compared with controls, group I patients had significantly lower LV systolic global 3D strain (43.7 ± 7.3% vs. 50.4 ± 6.6%, P = 0.02), twist (8.7 ± 1.3° vs. 11.4 ± 2.0°, P < 0.001), and twist gradient (1.5 ± 0.3°/cm vs. 1.9 ± 0.4°/cm, P = 0.01), greater SDI (6.8 ± 1.9% vs. 4.7 ± 1.9%, P < 0.001), and similar ejection fractions. Six patients in group I had perfusion defects, who had global 3DSTE parameters similar to those of the 8 patients without perfusion abnormalities (all P > 0.05). For group II patients, only the global area strain was significantly lower than that of controls (37.6 ± 3.5% vs. 40.7 ± 3.6%, P = 0.038). CONCLUSION In adolescents and young adults with a history of KD, impairment of LV mechanics occurs and is worse in patients with than those without coronary complications.
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Affiliation(s)
- Wei Yu
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Ansarin K, Toufan M, Namdar H, Etemadi J, Habibzadeh A, Valinejad M, Shoja MM, Ghabili K. Relation between exhaled nitric oxide and left ventricular performance in chronic hemodialysis patients. Ren Fail 2013; 36:35-8. [DOI: 10.3109/0886022x.2013.830225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sato Y, Maruyama A, Ichihashi K. Aging change of left ventricular function in children evaluated by acoustic quantification method. J Echocardiogr 2011; 9:97-102. [PMID: 27277176 DOI: 10.1007/s12574-011-0084-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 12/08/2010] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are few reports about acoustic quantification (AQ) in the area of pediatrics. We aim to determine normal values of AQ analysis and investigate the aging change of left ventricular function in children. METHODS The subjects in this study included 137 patients (aged 29 days to 18 years) who had normal cardiac function and no cardiac load. None of the patients were receiving medical therapy. The instrument used was a PH-6500 (Philips, Andevor). Change of left ventricular area in short-axis view was detected by AQ analysis. From the mitral inflow, peak early (E) and peak late (A) diastolic velocities were measured, and E/A was calculated. RESULTS End-diastolic area (EDA) and end-systolic area (ESA) increased with age. Fractional area change (FAC) decreased with age. Peak ejection rate (PER) and peak rapid filling rate (PRFR) decreased with age up to 10 years. Atrial filling fraction (AFF) decreased and E/A increased with age up to 5 years. CONCLUSIONS Maturational or developmental alterations in LV diastolic properties were found up to 5 years old. AQ analysis is one of the useful indexes for investigating left ventricular diastolic function.
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Affiliation(s)
- Yuko Sato
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Asami Maruyama
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Ko Ichihashi
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
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Niemann M, Breunig F, Beer M, Hu K, Liu D, Emmert A, Herrmann S, Ertl G, Wanner C, Takenaka T, Tei C, Weidemann F. Tei index in fabry disease. J Am Soc Echocardiogr 2011; 24:1026-32. [PMID: 21719255 DOI: 10.1016/j.echo.2011.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Systolic and diastolic dysfunction of the left ventricle are present in patients with cardiac involvement in Fabry disease. The aim of this study was to investigate the diagnostic value of the Tei index, a marker for combined diastolic and systolic function, in patients with Fabry disease. METHODS A total of 66 consecutive patients with genetically confirmed Fabry disease were included in this study. Standard echocardiography, including the Tei index, and magnetic resonance imaging were performed. Patients were followed for 2.9 ± 1.9 years; 56 patients received enzyme replacement therapy, and 10 patients had natural history follow-up. Patients were subdivided into three groups: (1) those without cardiac involvement, (2) those with left ventricular (LV) hypertrophy and without late enhancement on magnetic resonance imaging, and (3) those with late enhancement on magnetic resonance imaging. RESULTS The Tei index was significantly higher in the groups 2 (0.56 ± 0.10) and 3 (0.60 ± 0.16) compared with patients without cardiac involvement (0.44 ± 0.10) (P < .001). All patients with Tei indexes > 0.64 showed signs of cardiomyopathy. In contrast, ejection fractions were normal in all three patient groups and therefore not useful for the detection of cardiac involvement. A significant positive correlation was observed between LV wall thickness and the Tei index in the complete patient cohort. Moreover, receiver operating characteristic analysis revealed a large area under the curve for Tei index and hypertrophy, while the area under the curve for fibrosis was small. The Tei index remained unchanged in the natural history and enzyme replacement therapy groups during follow-up. CONCLUSIONS In this cohort, the Tei index was of limited value to detect myocardial fibrosis and monitor enzyme replacement therapy. However, the progression of cardiomyopathy toward LV hypertrophy seems to be paralleled by global functional impairment, which can be assessed by the Tei index but not by ejection fraction. Thus, the Tei index seems to be a global parameter that can detect LV functional reduction in patients with Fabry disease.
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Affiliation(s)
- Markus Niemann
- Department of Internal Medicine, University of Würzburg, Würzburg, Germany
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Sliem H, Nasr G, Ibrahiem D. Global left ventricular performance in non-diabetic non-hypertensive metabolic syndrome adults. World J Cardiol 2011; 3:48-53. [PMID: 21390196 PMCID: PMC3051148 DOI: 10.4330/wjc.v3.i2.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 10/10/2010] [Accepted: 10/16/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the left ventricular structure and function in isolated metabolic syndrome. METHODS One hundred and fifty six consecutive adults with metabolic syndrome were enrolled in the study. Fifty nine had isolated metabolic syndrome (group A) and 97 had metabolic syndrome with hypertension and/or diabetes (group B). There was a control group of 34 healthy adults. In addition to classic echocardiographic assessment of myocardial structural and functional changes, the Tei index was used to evaluate global left ventricular performance. RESULTS There were no statistically significant differences between group A and controls in all parameters of left ventricular structural, systolic, and diastolic function except global myocardial performance (Tei index). On the other hand, significant differences were observed between group B and the control group in most of the parameters of left ventricular structural and global performance. CONCLUSION The early identification of isolated metabolic syndrome in non-diabetic, non-hypertensive adults may be an indication that aggressive preventive measures should not be postponed until overt obesity, hypertension or diabetes mellitus has developed.
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Affiliation(s)
- Hamdy Sliem
- Hamdy Sliem, Department of Internal Medicine, Faculty of Medicine, Suez Canal University, 41522 Ismailia, Egypt
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